Family Nurse Practitioner Exam

A sexually active 30-year-old woman reports milk-like vaginal discharge with a vaginal pH of 6.0. What condition is most likely?

1. Trichomonas infection

2. Bacterial vaginosis

3. Candidal infection

4. A normal finding

The correct answer is: Bacterial vaginosis

The presence of a milk-like vaginal discharge coupled with a vaginal pH of 6.0 strongly suggests bacterial vaginosis. In bacterial vaginosis, the normal balance of bacteria in the vagina is disrupted, leading to an overgrowth of certain bacteria. This condition is associated with a characteristic thin, grayish-white discharge that can have a fishy odor, particularly after intercourse or during menstruation. The elevated vaginal pH of 6.0 is significant because a normal vaginal pH is typically between 3.8 and 4.5. In bacterial vaginosis, this pH rises above 4.5, which is not the case in candidal infections where the vaginal pH usually remains normal (4.0-4.5) despite the presence of a thick, white discharge. Similarly, trichomonas infections typically present with a frothy discharge and a higher pH as well but generally have other distinguishing symptoms such as pruritus and potential erythema. In summary, the combination of the discharge characteristics and the vaginal pH level are indicative of bacterial vaginosis, aligning with its clinical presentation and pathophysiology.